Maxillary Artery to Intracranial Bypass

Cerebral revascularization is used in the treatment of complex aneurysms and acute and chronic cerebral occlusive disease. Although superficial temporal artery–middle cerebral artery remains the workhorse of extracranial-intracranial bypass, several approaches have been developed during the past half century. The maxillary artery has shown feasibility in cadaveric studies, and usefulness in living patients, for achieving successful surgical revascularization. Although technically challenging and unfamiliar, maxillary-intracranial bypass offers the advantages of higher flow, good caliber matching, shorter graft length, calvarial protection of the interposition graft, and versatility for revascularizing multiple intracranial targets, including the intracranial internal carotid, proximal and middle cerebral, posterior cerebral, and superior cerebellar arteries. We discuss and review the evolution of, operative approaches for, and clinical applications of maxillary artery to intracranial bypass.